A 62-year-old man presents with ankle swelling after starting antihypertensive therapy. Which medicine is most likely contributing to the swollen ankles?

A 62-year-old man presents with ankle swelling after starting antihypertensive therapy. Which medicine is most likely contributing to the swollen ankles?

• A. Lisinopril
• B. Lercandipine
• C. Amlodipine
• D. Hydrochlorothiazide

Answer: (B)

Peripheral edema from antihypertensives is most commonly seen with dihydropyridine calcium channel blockers. These drugs mainly dilate arterioles, increasing capillary hydrostatic pressure in the legs. The result is fluid leaking into the interstitial space, which shows up as ankle swelling, especially with gravity when standing or walking. This side effect often appears within days to weeks after starting therapy or increasing the dose. Among the options, the one that belongs to this class is known for causing this pattern of edema, making it the best fit for the scenario. Other choices are less likely to produce this specific edema: ACE inhibitors can cause angioedema but not the typical dependent edema, diuretics like hydrochlorothiazide help reduce fluid, and while another dihydropyridine CCB can cause edema too, the identified drug represents the class most commonly linked to this effect. If the edema is troublesome, clinicians may consider dose adjustment or switching to a different antihypertensive class.

Peripheral edema from antihypertensives is most commonly seen with dihydropyridine calcium channel blockers. These drugs mainly dilate arterioles, increasing capillary hydrostatic pressure in the legs. The result is fluid leaking into the interstitial space, which shows up as ankle swelling, especially with gravity when standing or walking. This side effect often appears within days to weeks after starting therapy or increasing the dose.

Among the options, the one that belongs to this class is known for causing this pattern of edema, making it the best fit for the scenario. Other choices are less likely to produce this specific edema: ACE inhibitors can cause angioedema but not the typical dependent edema, diuretics like hydrochlorothiazide help reduce fluid, and while another dihydropyridine CCB can cause edema too, the identified drug represents the class most commonly linked to this effect. If the edema is troublesome, clinicians may consider dose adjustment or switching to a different antihypertensive class.